I have been preparing to give a presentation to nursing students at a nearby college. In doing so, I am reminded that the problem of substance abuse among healthcare workers, as well as the general public, is real and it is not going away. My focus has been nurses, I suppose because I am one, but the problem is not limited to nurses. I thought this week I would share some facts with you.

Nationwide:

2% to 18% of healthcare workers have some form of substance abuse, some say as high as 20%.

Prescription drug abuse is 25-30% of the entire drug problem in this country.

One health professional is arrested every 5.5 days; 70% nurses.

Nurses are 2X more likely to abuse prescription drugs than other healthcare professionals.

Hydrocodone is the #1 abused medication.

Alprazolam is #1 in its class.

Generally speaking:

$55.7 billion in costs related to prescription drug abuse in 2007.

115% increase in ER visits due to pharmaceuticals.

On an average day in the US:

More than 650,000 opioid prescriptions are filled

78 people die from an opioid-related overdose

In Wisconsin:

In 2015, for the first time, more people in Wisconsin died from opioid overdoses than in car crashes.

Opioid-related overdose deaths more than tripled in Wisconsin from 194 deaths in 2003 to 622 deaths in 2014.

Wisconsin has about 31,500 nurses, meaning more than 3,000 likely deal with substance abuse.

The BON received 717 complaints in 2015, these are not only substance abuse related.

Currently, 564 nurse professionals are actively being monitored as a result of a disciplinary order.

Currently, there are 34 nurse professionals enrolled in Wisconsin’s PAP (Professional Assistance Program), the program that allows confidential monitoring for addicted nurses that self-report.

Most commonly abused substances:

Alcohol

Opiates/Opioids

Central nervous system (CNS) depressants

Stimulants

There are many things being done at both the state and national levels to try and curb the increasing problem of addiction. If you are interested in learning more check out The Hope Agenda and the PDMP (Prescription Drug Monitoring Program) details below…

Perhaps you heard that the doctor who stood accused of overprescribing pain medications to such a degree that he was dubbed the “Candy Man” surrendered his license. In doing so he avoids punishment, both legal and financial.

If you don’t know the story of Dr. David Houlihan, a psychiatrist at the Tomah VA Medical Center, I will summarize it here…

Houlihan joined the VA in 2002 and went on to become chief of staff. Allegations, first made public in January 2015, reported that some patients had called the Tomah VA “Candy Land” and Houlihan “Candy Man” because it was so easy to obtain narcotics. Houlihan’s overprescribing led to at least one patient death, there are undoubtedly more. There was an investigation. Houlihan was placed on leave in January 2015 while the VA investigated the allegations and was fired on Nov. 9, 2015. In March of 2016, when investigators learned Houlihan had opened a private psychiatry practice in La Crosse Wisconsin, his medical license was suspended due to overprescribing of narcotic painkillers. The next month his license was restored because “the Division has not met its burden of establishing that the emergency suspension of Respondent’s license should continue while the case on the merits of the Division’s allegations is pending.” He was allowed to continue to practice medicine while his case was reviewed by the VA and the licensing board. Now, finally, he has lost his license for good. In an agreement, Houlihan voluntarily surrendered his medical license and avoids prosecution. He will never practice medicine in Wisconsin again. He must close is practice in La Crosse within 30 days. For more details on his case please see the references below.

I am so glad to know that this doctor will no longer practice medicine in this state (I hope other states don’t fall prey to him). But I know there are many more like him. And they are not only doctors – nurse practitioners, physician assistants, anyone with a license to prescribe these medications can abuse this privilege. They contribute to our problem of addiction, a sizable percentage of it. I am not blaming all prescribing professionals for the addiction epidemic that has Wisconsin in its grip. The majority are caring professionals do a wonderful job, but there are those that overprescribe. That overprescribing leads many patients into addiction and all that goes with it.

There is a report put out by the DEA that lists doctors that were found guilty of crimes, so many of them are drug related. Take a look through it, you may be surprised at the sheer volume of doctors that use their medical license to act as drug dealers. Many get jail time, some just get a slap on the wrist. It is interesting reading…

Last week the Governor’s Task Force on Opioid Abuse met to release recommendations to address the opioid epidemic in our state. The link above is the full document regarding the issues at hand as well as their recommendations. I am also listing some of their recommendations here (along with my 2 cents) for ease of reference…

To develop these recommendations, task force meetings were held all across the state of Wisconsin. In collaboration with health care providers, law enforcement, public health officials, the tribes, and our state agencies, the task force listened to experts, looked at best practices from across the country and across Wisconsin, and heard from the people and families impacted by this crisis of Opioid Abuse.

LEGISLATION AND STATUTES

We recommend legislation permitting school personnel such as school nurses to administer an opioid antagonist such as Naloxone to a student on school premises if a student overdoses while at school.

We recommend permitting UW’s Office of Educational Opportunity to charter a recovery school so that students who need in-patient care can receive it without missing a semester or year of school.

My 2₵-This is an invaluable idea. If we can offer help and yet support their education, some students may actually succeed where otherwise they would have failed and lost everything. Of course not all will accept this option, many will fail, but for those who succeed the benefits to society are huge.

We recommend amending the state statutes to permit relatives to commit a drug-addicted family member in the same fashion we currently allow for alcoholism.

FUNDING AND PROGRAMS

We recommend spending $150,000 to fund two additional fellowships to train addiction physicians.

We suggest a “Recovery Corps”. For $60,000, we could annually train 20 recovery specialists to serve at substance abuse and peer support sites.

We also recommend a grant program to allow up to 25 hospitals with high rates of drug overdose care to hire in-house recovery coaches. These coaches would be responsible for ensuring a smooth hand-off from in-patient care for an overdose to in or out-patient care for addiction. We propose dedicating $2,000,000 to begin this program with the hope that hospitals will find value and consider continuing it after the pilot phase.

We recommend $500,000 to support recovery coaches and peer specialists in community corrections settings with high concentrations of addict offenders.

My 2₵ (for the last 3 items)-These are a no brainer. It is those who have gone through the same struggles that can best help the addict. There are things only addicted individuals can understand and having the support of someone who has been there is critical when working with addicts, in my opinion anyway.

We recommend $2,016,000 in funding to support the start-up of three new medically assisted treatment (MAT) centers that provide assessment, counseling, treatment, and intensive case management services to many individuals looking for addiction support, but also housing and employment, in underserved areas of the state.

My 2₵-It is the underserved that suffer the most. They often start out at a disadvantage, economically, socially etc, but they also lack the resources to show them a better way, or to help when they are ready to seek it. Other than jail and life on the street, their options are few. They need help, and I hope this will give them that.

An Addiction Treatment & Recovery Hotline at DHS. Staffed by trained counselors and peer specialists, the call center and website would connect people to resources in their region, help them navigate insurance or Medicaid, and be a listening ear in a difficult hour. We expect the hotline to require $400,000 annually to operate.

We recommend $1,000,000 to provide competitive community Innovation Grants to implement the best treatment ideas developed by community coalitions. The funds will focus on expanding MAT treatment, especially in conjunction with drug courts, and expanding recovery services.

DHS will expend $1,000,000 to support education, training, and access to Naloxone through non-profits that serve high-risk populations, including our veterans.

My 2₵-This is so important. Recently, legislation was passed to make Naloxone available without a prescription to communities and individuals in Wisconsin. There is not, however, current education for communities on who should have it handy and how and when to use it. I think this is critical to compliment the increased availability of Naloxone.

We propose $420,000 to hire additional Criminal Investigation Agents at DOJ to focus specifically on drug traffickers operating in Wisconsin.

We recommend increasing funding for drug courts and other alternatives to incarceration for minor, drug-only offenses because social science and personal experience convince us that they work. The program was previously funded at $2 million per year in a one-time biennial transfer; we recommend continuing that funding and adding $150,000 to expand the program to more counties.

We recommend $261,000 to launch a pre-booking diversion pilot program to allow non-violent arrestees a treatment option that diverts them away from the criminal justice system and into support and healing in the community.

My 2₵-This is so important! We need alternatives to incarceration for addicts. It does not work to lock them up and forget about them. Without treatment, they will most likely return to the same behavior upon release. With treatment they have a shot at overcoming the addiction and staying out of jails and prisons. Is it expensive? Probably. But so is incarceration.

We propose appropriating $250,000 to fund three staff to operate a data analysis center. Working with our agencies, they will develop a dashboard for opioids data which will be used to develop our state needs assessment and statewide strategic plan.

To identify addicts and to better prepare people for the Wisconsin workforce, the Governor has ordered DHS to seek a federal waiver to conduct drug screening and testing for able-bodied adults without dependents who participate in FSET (FoodShare Employment and Training) as part of the supplemental nutrition program. Importantly, anyone who fails the drug screen will be provided treatment.

My 2₵-Not to punish those on food stamps who are addicts, but to get them help so they can one day join or rejoin the workforce and have a life.

EXECUTIVE ACTIONS

DOC should consider developing a recovery housing unit within an institution where inmates would voluntarily commit to living clean after release, participating in an addiction program, and supporting their fellow inmates in their common battle for healing.

My 2₵-Yes, Yes, Yes!!!!

The Department of Safety and Professional Services should dedicate all necessary resources to ensuring the efficacy of the Prescription Drug Monitoring Program (PDMP). As the PDMP becomes mandatory for three years, we expect DSPS to see an increase in investigations and enforcement actions based on the data it makes available.

My 2₵-I have talked about the PDMP before. It is a great tool, but it must be reviewed! Requiring doctors and pharmacies to enter prescription information is only good if someone is reviewing the data for problems and following up on them when they are brought to light. I would like to see the investigations and enforcement actions publicized so we can be aware of the prevalence of the issues.

DVA (Department of Veteran’s Affairs) should ensure that its Division of Veterans Homes provides care in line with best practices for opioid prescription and pain management. In particular, home residents with opioid prescriptions should have individualized plans of care that may include non-pharmaceutical treatment options. Moreover, DVA medical and pharmaceutical staff should ensure that opioid prescribing is in line with best practices recommended by the Medical Examining Board.

DVA should promote public awareness among the veteran community of opioid related resources, for instance by ensuring that DVA and county veterans services staff, homeless veterans service providers, and DVA grantees and allies have information on opioid abuse.

My 2₵-Thank God Veterans are included in this task force’s recommendations. They are an underserved group and need much help. I hope this gives those Veterans who struggle the support they need.

BEST PRACTICES FOR INDUSTRIES AND COMMUNITIES

Because we intend for Medicaid to set the best practices for coverage, we encourage all other health insurance providers to bring their own policies in line with Medicaid to ensure all citizens in Wisconsin have access to appropriate treatment for both pain and addiction.

The task force offers these recommendations to ensure their consideration in the biennial state budget process. I will follow the progress of the task force and update you all as things, hopefully, progress. I think this is a good start.

At only 24 years of age, Shuntaye Crenshaw was found guilty of first-degree reckless homicide/delivery of drugs in the death of Caleb Ford, just 18 years old, and now faces up to 25 years in prison at his sentencing in January. Ford, a student at Concordia University student, had a history of drug use. He and some friends pooled their money and bought a combination of drugs from Crenshaw. Ford died as a result of combining heroin (snorted) and Xanax. His roommate and two friends were charged with possession and kicked out of Concordia. 5 lives forever changed. Two of them lost, one died and the other will spend much of the next couple of decades behind bars. It hardly seems worth it, yet that is the game played by so many. Every time drugs are sold or bought, delivered or consumed, people are taking this risk.

There is a statute in the state of Wisconsin whereby the person who delivers drugs to someone, if that someone dies, can be charged with first-degree reckless homicide. I have linked the statute and included the relevant text below. If the drugs change hands multiple times, each person that sold or delivered the drugs can be charged. The drugs do not need to be sold, just delivered. So if you give your pills to someone, and they overdose, you could be charged with this crime. The price is steep, up to 25 years.

Let’s look at a couple scenarios. A high school junior takes Vicodin, that his Dad had left in the medicine cabinet after his knee surgery, to school with him and gives some to his best friend. That friend takes them to a party that night and passes them around. They drink on top of taking the Vicodin and one of the party goers dies as a result. Both the kid who took them from his Dad and his best friend could be charged with first-degree reckless homicide/delivery of drugs. How about the Mom, leaving on a business trip, who gives her teenage daughter a few OxyContin, that she has for her own back pain, to take for her menstrual cramps. She tells her to take one every twelve hours and that she’ll see her tomorrow. But the daughter, having seen her Mom take a few at a time, takes 3 and never wakes up. Her Mom finds her the next day. Not only has she lost her daughter, but she faces the real possibility that she could face time in prison for first-degree reckless homicide/delivery of drugs.

While Wisconsin prosecutors are becoming more aggressive in charging these types of crimes, the legal consequences vary widely. Some may get years in prison, others just a few months in jail, others are never charged. But as the drug problem continues to grow, the necessity to do something will require prosecutors to take a closer look at how to deal with these cases. Perhaps fear of imprisonment will make people think twice, perhaps not. But knowing it is criminal to ‘share’ their prescription drugs, may prevent some from doing it.

I’m not sure that locking up a high school student or a Mom, who lost their friend or daughter due to an error in judgement, is the right thing to do, but I do think we need to hold people accountable for their behavior. Maybe we force them to share their story at high schools, hospitals and/or churches across the country. Maybe they write a book with profits, if any, going towards getting their story distributed to high schools, hospitals and/or churches across the country. I’m not sure. But let’s not let these types of events pass by without recognition. Let’s tell the stories and learn from them. Let’s open our ears and listen. Let’s share what has happened to us so that others learn what they can do to prevent this opioid epidemic from growing even more.

(2) Whoever causes the death of another human being under any of the following circumstances is guilty of a Class C felony:

(a) By manufacture, distribution or delivery, in violation of s. 961.41, of a controlled substance included in schedule I or II under ch. 961, of a controlled substance analog of a controlled substance included in schedule I or II under ch. 961 or of ketamine or flunitrazepam, if another human being uses the controlled substance or controlled substance analog and dies as a result of that use. This paragraph applies:

1 Whether the human being dies as a result of using the controlled substance or controlled substance analog by itself or with any compound, mixture, diluent or other substance mixed or combined with the controlled substance or controlled substance analog.

2 Whether or not the controlled substance or controlled substance analog is mixed or combined with any compound, mixture, diluent or other substance after the violation of s. 961.41 occurs.

3 To any distribution or delivery described in this paragraph, regardless of whether the distribution or delivery is made directly to the human being who dies. If possession of the controlled substance included in schedule I or II under ch. 961, of the controlled substance analog of the controlled substance included in schedule I or II under ch. 961 or of the ketamine or flunitrazepam is transferred more than once prior to the death as described in this paragraph, each person who distributes or delivers the controlled substance or controlled substance analog in violation of s. 961.41 is guilty under this paragraph.

(b) By administering or assisting in administering a controlled substance included in schedule I or II under ch. 961, a controlled substance analog of a controlled substance included in schedule I or II of ch. 961 or ketamine or flunitrazepam, without lawful authority to do so, to another human being and that human being dies as a result of the use of the substance. This paragraph applies whether the human being dies as a result of using the controlled substance or controlled substance analog by itself or with any compound, mixture, diluent or other substance mixed or combined with the controlled substance or controlled substance analog.

I came across the above articles and I found them interesting, although a bit worrisome. Due to the ever increasing addiction to prescription pain medicine, someone new has stepped in to join in the fight. They are health insurance companies.

Companies such as Aetna, Blue Cross Blue Shield and Cigna have taken measures over the past several years to prevent deaths and keep addiction numbers from growing by monitoring the overprescribing of prescription painkillers such as oxycodone, hydrocodone and morphine. Their reasons may not be altruistic, but it makes good business sense. The cost to public and private insurance companies of prescription painkiller abuse, treatment and “diversion” (when patients sell the medication instead of taking it) is an estimated $72.5 billion a year.

Because these insurance companies play a big financial role in health care, they might be able to make some of the most impact, says Dr. Andrew Kolodny, a senior scientist at Brandeis University’s Heller School for Social Policy and Management. “They’re paying the bills,” Kolodny said. “They’re paying for the medicines that people are getting addicted to. They’re paying for the doctors’ visits where people are getting medicines prescribed.”

For years, these companies have had access to prescription information for its customers. Any time you fill a prescription using your insurance, the company knows about it. The new measure will flag those customers who are deemed high-risk — either for getting large amounts of opioid medicines, for getting narcotics from different doctors or for being on the medicines for a long time — and getting in touch with those customers’ doctors. They reach out to the doctors who are prescribing to these patients to let them know such a history exists. This enables doctors to make appropriate decisions based on a patient’s history.

If the doctor believes that addiction may be an issue, the insurer can help get him or her get information about covered treatment options. If the doctor feels the patient still needs to be prescribed long-term narcotics, the insurer can limit where the patient is able to fill the prescription and which doctors are able to prescribe narcotics to them. This way the doctor can closely monitor the patient’s use and make valuable decisions regarding their care. If the patient goes to other doctors or pharmacies asking for narcotic painkillers, the insurer cannot tell the pharmacy not to fill a prescription; they would simply not pay for it.

There are databases that look at what kinds of prescriptions a patient has been filling — called Prescription Drug Monitoring Program databases (I’ve talked about this in previous blogs)—that generally pull together data in each state. But it’s difficult for some doctors to know what prescriptions patients are filling in other states.

The insurers also offer information on “medication-assisted therapy” — which combines therapy with addiction treatment medicine such as Suboxone.

So how do insurers propose to reduce addiction based on monitoring prescriptions? If a patient is getting more than 30 days worth of prescription painkillers, the doctor has to get prior authorization from the insurance company and must assess the addiction risks for that patient. Oftentimes, patients are required to sign “treatment plans” in which they acknowledge that they know about the risk of addiction with opioid medicines and promise to get these prescription painkillers from only one doctor. Insurer’s aim is to reduce the number of opioid prescriptions written to its customers by 25%, back to the number of prescriptions that were being written in 2006, which the insurer calls “pre-crisis.”

Preauthorization, as many of us know, can be a cumbersome and time consuming process. It is easier to write a prescription for 29 days to bypass that requirement. Prescribers do not have a lot of time to do a risk assessment for each patient that requires opioids. Signing a document can be done without much thought by someone who just wants the painkillers. If patients pay cash for their medication and don’t use their insurance (as many do), they will not be flagged. Insurance companies that base their decisions on money instead of patient need cannot see what issues that patient may be experiencing. These are some of the problems I see with the insurance companies making such decisions. But I also think this may be a valuable tool in the fight against over-prescribing. Awareness is often key in realizing the scope of a problem. Maybe some prescribers will use the information provided to get their patients help if addiction exists.

I think we can use all the help we can get in the fight against addiction. But, we need to be careful. What we do with that information will effect the quality of life for patients. Insurance companies will base their decisions financially. Prescribers must base their decisions on the needs of the individual patient. It takes time to evaluate each patient and to decide if the patient is truly in need or if they are drug seeking, or both. Do they need other services such as physical therapy or other pain management techniques? There are many things that can be done to help those with chronic pain and prescription medications are only one piece of that. Let’s prescribe responsibly.

Narcotic deaths: The number one cause of accidental deaths, now exceeds auto accident deaths. Since the turn of the century, there has been a several fold increase in the use of heroin, and as a result, an 11-fold increase in heroin deaths. It’s the same story we have heard too often as of late, kids are dying from opiates. Sometimes, because they mix the drugs with alcohol, sometimes because they progress to heroin and overdose, and sometimes because they take their own life because the pain is too great. Every time it happens it is devastating to the addict, their families and their friends.

A kid takes a pill at a party, not really knowing what it is, then pours some alcohol on top of it. They go to sleep and sometimes they don’t wake up. The combination causes respiratory depression, respiratory arrest, cardiac arrest and death. The friends that find them in the morning are forever changed. Nobody meant any harm, it was just one pill, just a couple of drinks. What those kids don’t realize is they are playing Russian roulette with their lives. Those who hand out the pills are handing them the gun. What starts as an innocent desire to have a good time, all too often ends in tragedy. Those kids didn’t intend to die, the friend who gave them the pill certainly didn’t want to cause harm, yet lives are forever changed because of a couple of poor decisions. Kids need to understand the danger and they need to hear stories like those that are talked about in this news story (link at top of page). These are real lives snuffed out by opiates. It happens far too often when it shouldn’t happen at all.

Sometimes kids start with Vicodin, Percocet or something similar. They get it from their parent’s medicine cabinet, they get it from friends, innocently enough most times. But something happens to some, an addiction is awakened in them, they need to have more. No way to tell who will fall prey. When they visit friend’s or other family member’s homes they go through their medicine cabinets looking for more drugs. They may fake pain to get a doctor to prescribe something. They very well may buy the drugs from someone at school. The pills are everywhere. They will start to steal things to pay for them because they are very expensive. Then someone will tell them how much cheaper heroin is. They’ll try it. They’ll love it. The high is better, faster, the addictive properties of heroin will overtake them and they will no longer be able to control their desire for the drug. All too often, they will overdose and die. They didn’t intend to become an addict, and certainly didn’t intend to die so young. Even if they don’t overdose, their lives are tortuous. There isn’t anything pretty about an addict’s need to do whatever they can to get their drug. They will lie, cheat and steal, often from the people they love the most. They deny help because they can’t imagine living without their drug.

If they don’t end up dead, a life of drug addiction is no picnic. Pain, depression, anxiety, loneliness, desperation, jail, mental institutions, living on the street-these are the things that addicts have to look forward to. Sometimes death is preferable and suicide becomes the only foreseeable option.

The drugs don’t care if you are a boy or a girl, if you are black or white, if you have a lot of money or a little. Kids with difficult lives become addicts; kids living in privilege become addicts; kids anywhere in between become addicts. Drugs are an equal opportunity destroyer, they are patient and seductive. We all need to work together to stop addiction before it starts because once it starts it is so difficult to stop. Too many of our young people are dying. What can we do to help? Here are some ideas, if you have more ideas please leave comments here. We need all the help we can get, we need to band together and fight. Fight for our kids.

-If you are saving your prescription bottle of opiates for a future time when you might need it, GET RID OF IT. There is no good reason to keep these dangerous drugs around ‘just in case’. You need to get them out of your house. If you need them in the future, you can always get another prescription. Unfortunately, doctors are often too liberal with prescribing opiates.

-If you have pain, try a non-narcotic intervention first. Don’t automatically accept a prescription for an opiate. Other things work too, even less powerful pain relievers and non-pharmacological things work. Ask your doctor if there is something else you can try. If you do need opiates, take them with caution and keep them locked up…

-If you must have opiates or other controlled substances (pain medications, antianxiety drugs, drugs for ADHD, antidepressants, etc.) in your home, LOCK THEM UP. There are many different ways to do this, but a strong safe with a combination lock is a good choice. One that can’t be easily moved or broken into is best.

-Narcan or Naloxone (reverses the effects of opiates) can now be obtained without a prescription in some states, Wisconsin is one of them. If you know someone who suffers from an opiate addiction you should have this readily available in case of an overdose. The cost is $20-$40. Small price to pay for this life saving medication.

If you think this silly, that this couldn’t happen to you; your kids are safe; the opiates in your medicine cabinet won’t hurt anyone, please think again. It can start so innocently. All it takes is one pill. One time. Protect your kids, my kids and everyone’s kids.

On September 27, 2016, Governor Scott Walker released the launch of a task force to address the use and abuse of heroin and prescription opioids. As stated in the public health advisory letter, “This health advisory is being issued by the State Health Officer to inform the public of the alarming statistics of the current opioid epidemic in Wisconsin.”

The number of Wisconsin citizens who die as a result of drug overdose now exceeds the number of those who die from motor vehicle crashes, as well as suicide, breast cancer, colon cancer, firearms, influenza, or HIV. Opioid-related overdose deaths more than tripled in Wisconsin from 194 deaths in 2003 to 622 deaths in 2014. They are now a leading cause of injury deaths in Wisconsin. Prescription opioid pain relievers such as oxycodone, hydrocodone, and methadone contributed to about 45% of the total number of drug overdose deaths, and heroin contributes to about 27%.

Improve the way opioids are prescribed; promote the use of the prescription drug monitoring program (PDMP), I explained this program in depth in my blog in April of this year (http://blog.unlikelyaddict.com/?p=113); expand access and use of naloxone, or Narcan, an opiate reversal medication; expand access to evidence-based substance abuse treatment; continue to enhance collaboration with others (states, local agencies, healthcare providers) to collaborate on ways to reduce opioid abuse.

They call it an escalating epidemic, which, of course, it is. So how are they going to accomplish the above objectives? Well, they have a 5-year plan, detailed here…https://www.dhs.wisconsin.gov/hw2020/wi-hipp.htm, working through the Wisconsin Health Improvement Planning Process (WI-HIPP).

They are asking for people to get involved, if you are interested in doing so, you can email them at this address…

DHSHW2020@dhs.wisconsin.gov. I emailed them today to offer my assistance in whatever capacity they feel may be useful. As a nurse in recovery, as a citizen of Wisconsin, as an opiate addict in active recovery (meaning I work a 12 step program), I think I have something to offer.

Part of this plan, that has already been put into action is to make naloxone available without a prescription. This drug reverses the effects of opiates so that if a person overdoses and is given naloxone, they have a very good chance of surviving. This is a huge step that will save lives.

I am encouraged to know that the state recognizes the depth of the opioid problem, but I am concerned that real progress will be slowed by the political process. There are many departments included in this task force, sometimes the more people involved, the slower the progress. But, for now, I am grateful to know that those with the ability to effect change understand the crisis and are willing to take steps to try and improve the situation. To help ease the epidemic that is devastating so many individuals and families.

Wisconsin Nurses Association (WNA)has a peer assistance program called “Nurses Caring for Nurses”, see above link. The program is a voluntary and confidential advocacy program for Wisconsin nurses and their employers. The program was established in 1993 as awareness about the growing need of chemically dependent nurses was realized. The program offers education, awareness, support in recovery and advocacy. This program is not affiliated with the Department of Regulation and Licensing or the Wisconsin Board of Nursing.

The program’s objectives:

To serve as a resource for nurses with questions about alcohol and drug use.

To provide support and advocacy for nurses seeking assistance with recovery through WNA’s “Nurses Caring for Nurses” Program.

I am so glad to know that Wisconsin has this resource available. What concerns me is that I didn’t know anything about it. I successfully completed the Wisconsin Board of Nursing’s Monitoring program in 2010. In the 5 years I spent completing the program, I was never told about or offered this advocacy program. Other nurses in the same situation haven’t heard of it either. What good is a program if those who need it most have never heard of it? The two are not affiliated, the Wisconsin Nurse’s Association’s (WNA) “Nurses Caring for Nurses” and the Wisconsin Board of Nursing’s (BON) monitoring program, why is that? It seems to me that the BON would benefit, as would the nurses enrolled in their monitoring program, by such an affiliation. At a minimum the BON should let nurses struggling with addiction know that such a program exists, that there are others in their exact situation that they can talk to and get support from. I know this would have helped me tremendously.

So I emailed them to ask a few questions. The BON said they could not help me and connected me with the WNA, that is how I found out about their program. When I emailed again to ask more questions they did not reply. So I called Gina at the WNA, she is the “Nurses Caring for Nurses” contact, but she has not returned my call. Hopefully she will, maybe I can join them as a resource. At a minimum I would like to get the word out that “Nurses Caring for Nurses” exists, this blog is a start. I will keep trying to contact them to see how I can help. I will ask the WNA and the BON to work together to let those in the BON’s monitoring program know about this advocacy program. I think it would increase success for those going though monitoring, in fact I know it would. Now I just need to get the BON and WNA to agree…

For more information or to request support from “Nurses Caring for Nurses”: 800-362-3959 Ask for Gina

Pill mills are a problem in Wisconsin. Here is just one example – on June 24th of this year the Milwaukee Journal Sentinel online reported that a doctor, Steven Kotsonis and office manager, Susan Moyer from a Wauwatosa medical office, were arrested on charges including conspiracy and illegally providing drugs to patients. The indictment stems from an investigation into whether they illegally provided drugs to patients from the Compassionate Care Clinic on W. Capitol Drive in Wauwatosa in 2012 and 2013. Moyer, who described herself as the “Oxyczar” and Kotsonis face 20 years in prison if convicted on all of the counts they face. Federal sentencing guidelines make that very doubtful, they will likely serve a fraction of that, IF they are even convicted.

Moyer accepted cash for prescriptions for large amounts of prescription narcotics. Kotsonis signed the prescriptions, often times without even seeing the patient. This is an example of a pill mill, in our own backyard.

What is a pill mill exactly? Basically, a pill mill is a business in which a doctor, clinic and/or pharmacy prescribes and/or dispenses narcotics without a legitimate medical purpose. They can be difficult to detect, but some warning sign are…

No physical exams are performed

Pain is only treated with pills

Patients congregating in the parking lot

Patients are in and out of the doctor’s office in minutes

Excessive traffic to and from the doctor’s office

Complaints from pharmacists about doctor’s practices

Complaints from neighboring business owners about clientele

Cash is the only payment accepted

Large cash deposits at the bank

The local and federal governments are responsible for finding these types of criminals, because that’s what they are-greedy criminals, and taking care to stop them. But, it takes a long time to complete these investigations. For Kotsonis and Moyer, the offences resulting in the charges they now face and were arrested for 2 months ago, were committed in 2012 and 2013. The clinic under fire was closed, but nothing has happened to “Dr.” Kotsonis’s license. There is no record of any investigation or disciplinary action on his license by the state of Wisconsin. In fact, he is practicing again through the Stevanovic Family Clinic in Milwaukee, introduced simply as “Dr. Steven”. How is it possible that he can continue unabated after what he was responsible for? At a minimum, we should be able to see that he was investigated, that he has to account for what he is now doing, that he can’t write prescriptions, or at least that they are monitored. But there is none of that, why?

When I was arrested and charged I was fired, and legitimately so. My license was suspended and to get it back I had to do many things to prove I had changed my behavior. This seemed reasonable to me, I had stolen and used drugs and I needed to show that I wasn’t going to do that anymore. My punishment fit my crime. But for these two goofballs, there seems to be no consequence over the last few years. If there has been, it is not documented anywhere that I can find. This does not seem right, we need to change the way we address these types of crimes, these pill mills.

The doctor in this Healthline article, Dr. Tseng, ran a pill mill that resulted in the death of college student who was just a few months shy of graduating. He and his friends got prescriptions for Oxy and Xanax from Tseng and mixed them with alcohol. Tseng was charged in his death, the charge was second-degree murder, she was convicted and sentenced to 30 years to life in prison. She’s the first doctor in this country to be charged and convicted in a case stemming from running a pill mill. Even though she had been notified that one of her patients had died of an overdose from the drugs she prescribed, she did not change her prescribing habits…no remorse. No remorse that is until she found herself facing 30 years to life in prison. I hope that other people running pill mills hear of her story and change their ways. Places such as these are escalating the opioid addiction problem, making it far too easy to get these dangerous drugs. They must be stopped.

In light of the ever increasing problem of addiction, the federal government is looking more closely at questionable practices. The above article gives many examples of clinics, doctors and pharmacists that have been caught and indicted. What happens then is up to the courts, and I hope the licensing boards remove the rights of these people to prescribe narcotics permanently. Unless there are severe consequences the greed will overpower the fear of being caught and the pill mills will continue.

If you see evidence of a pill mill in your area, tell someone. Since they are federally regulated, I suggest starting there. We have to work together to make a difference. We have to work together to make our neighborhoods safe from these places and their clientele. We cannot let them continue, we just can’t.

Today I would like to share a bit about the Florida Board of Nursing’s “Intervention Project for Nurses” or IPN. It is similar to other Diversion Programs that many states have, including Wisconsin, but it has a piece to it that is a bit different…they have a statewide support groups for nurses. This interested me, what a great idea. To have nurses that have been through the same issues talk to those who are beginning their journey is a very valuable tool.

“The mission of IPN is to ensure public health and safety by providing an avenue for swift intervention/close monitoring and advocacy of nurses whose practice may be impaired due to the use, misuse, or abuse of alcohol or drugs, or a mental and/or physical condition. IPN is authorized by Florida Statute, Chapter 464/456, to assist those nurses whose practice is affected.”

“Program Objectives…

To ensure public health and safety through a program that provides close monitoring of nurses who are unsafe to practice, due to the use of drugs including alcohol and/or psychiatric, psychological or a physical condition (chapter 455.261).

To provide a program for affected nurses to be rehabilitated in a therapeutic, non-punitive, and confidential process.

To provide an opportunity for retention of nurses within the nursing profession

To facilitate early intervention, thereby decreasing the time between the nurse’s acknowledgment of the problem and his/her entry into a recovery program.

To require the nurse to withdraw from practice immediately, and until such time that the IPN is assured that he/she is able to safely return to the practice of nursing.

To provide a cost effective alternative to the traditional disciplinary process.

To develop a statewide resource network for referring nurses to appropriate services.

To provide confidential consultations for Nurse Managers.”

Most of these objectives correlate with what we have here in Wisconsin. But like I said, the support network is different. The IPN has a vast network of resources for nurses. Florida has 150 Nurse Support Groups throughout the state. Each group has a facilitator. This is what one had to say, “I have been a Nurse Support Group Facilitator for over 12 years. I have witnessed many nurses come and go from my groups. The “magic” of the Nurse Support Group lies in the fact that a nurse who feels totally alone and full of negative self-talk and shame, secondary to his or her substance use disorder, attends group with other colleagues who have struggled with similar feelings and circumstances. There is a realization that “I am not alone anymore” and hope is born.” And one of the participants shared this, “Walking into my Nurse Support Group the first time surprised me. I will never forget the experience. My first surprise was how welcoming folks were to me. I listened as members shared a little about themselves with me, and I was amazed how similar the stories were to mine! I left that night with a sense of hope.”

I am going to write to the Wisconsin Board of Nursing (BON) to suggest we start a program like this one and I am going to offer to help get it going. I’m not sure how far I will get, but it is worth a try. I know when I first started this journey, I needed to speak to other people going through what I was. I was lucky in the sense that my counselor had another nurse she was treating with almost the exact same issues. What I didn’t have was someone who had been successful in going through the BON’s program and returning to practice. It would have been very helpful to have someone walk me through the process. As it was, I fumbled around with a lot of anxiety and some missteps. I would love to be a resource for nurses new to the BON monitoring program and new to sobriety. 12 step programs are essential in my opinion and they have worked so well for me, but they do not include anything about how to recover as a nurse. Including how to navigate the overwhelming program requirements, how to deal with the feelings of shame and remorse, how to get to a point where working as a nurse is a possibility again. I could be that resource, there are many like me that could. Let’s get together to make a difference in this lovely state of Wisconsin. If you are a nurse in recovery and would like to join me in my quest, please use the ‘Contact Us’ form and send me an email with your contact information. Together we can make a difference.

Excellent Support

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